^18F—FDG PET肿瘤学应用进展

ＰＥＴ在肿瘤学方面的临床应用越来越重要。＾１８ＦＤＧ（＾１８Ｆ－ｆｌｕｏｒｏｄｅｏｘｙｇｌｕｃｏｓｅ）ＰＥＴ被广泛应用于多种癌症，对癌症的诊断及分期，它是一种最准确的非创作性的诊断技术。它可用于多种肿瘤的手术、放疗及化疗的疗效监测和评价。借助ＰＥＴ的检查结果，有助于及时调整治疗方案，避免不必要的治疗及其带来的副作用和浪费。     

^18F—FDG PET显像鉴别诊断肾上腺良恶性肿瘤的临床价值

１８ＦＦＤＧＰＥＴ显像鉴别诊断肾上腺良恶性肿瘤的临床价值王辉ＳｉｍｏｎｅＭａｕｒｅａＣｉｒｏＭａｉｎｏｉｆｉＭａｃｒｏＳａｌｖｏｔｏｒｅ朱承谟张冀先管临床上诊断肾上腺肿瘤主要用Ｂ超、ＣＴ或ＭＲＩ，但在鉴别良恶性方面均有较大局限〔１〕，放射性核素肾...     

FDG PET在肝脏恶性肿瘤诊断中的应用

目的　评价PET诊断恶性肝肿瘤的价值及其局限性。方法　肝内良性占位病变患者10例 ,其中肝囊肿 6例 ,肝血管瘤 4例 ;肝内恶性病变患者 2 8例 ,其中肝细胞肝癌 (HCC) 13例 ,胆管细胞癌 (CCC) 1例 ,转移性肝癌 14例。按体重注入 5 .5 5MBq/kg18F 脱氧葡萄糖 (FDG) ,使用SiemensE CATEXACTHR+ PET仪采集和重建图像。根据FDG摄取将病灶分为 3种类型 ,A型 :病变部位摄取高于周围正常组织 ;B型 :与周围组织相近 ;C型 :低于周围组织或无摄取。结果　 9例HCC和 1例CCC为A型 ,标准摄取值 (SUV)为 3 0 2± 1 33。 3例HCC为B型 ,1例为C型。 14例转移性肝癌PET共发现转移灶 19个。结论　FDGPET可对肝内病灶进行定位、定性及转移的早期诊断 ,但应警惕HCC显像的特殊性 ,以免误诊或漏诊。     

^18F—FDG PET显像与^99Tc^m—MDP全身骨显像诊断肿瘤远处转移的比较

目的 评价^18F-脱氧葡萄糖（FDG）PET肿瘤显像与^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像对检出骨和远处转移的价值。方法 对16例恶性肿瘤放化疗后的患者进行^18F-FDG PET显像和^99Tc^m-MDP全身骨显像，并对两种结果进行了比较。结果 16例肿瘤患者中^18F-FDG PET显像皆阳性，其中14例患者有远处转移，转移病灶共62处，其中骨转移病灶20处；在全身骨显像中，11例有局限性异常放射性浓聚，其中2例为单一病灶，9例为多发病灶，共检出病灶57处，另5例骨显像正常。结论 ^18F-FDG PET对恶性肿瘤的诊断具有较高的准确性和特异性，但对骨转移灶的诊断价值相对较差；^99Tc^m-MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行^18F－FDG PET检查，以明确诊断其他远处转移灶。     

18F-FDG PET显像在原发不明转移癌中的诊断价值

目的：探讨18F－脱氧葡萄糖（FDG）PET显像在原发不明转移癌中的诊断价值。方法：23例原发灶不明转移癌患者，进行18F－FDG PET显像，并与临床随访，活组织检查和手术病理结果相对照。结果：23例患者中18F－FDG PET发现可凝原发灶10例，其中8例病理结果证实为原发灶，1例经长期随访证实为原发灶，1例病理结果为阴性，18F－FDG PET对原发灶检出率为39％，18F－FDG PET全身显像共检出淋巴结和远处转移灶16个，CT和（或）MRI只检出9个，13例18F－FDG PET检查未确定原发灶者，随访3个月－1年，死亡4例，9例18F－FDG PET检查确定原发灶者，随访2个月－1年，死亡1例。结论：18F－FDG PET显像对原发灶不明转移癌原发灶的诊断，淋巴结和远处转移的分期，治疗方案的制定以及预后判断均有一定的临床价值。     

^18FDG-PET和^99mTc-MDP骨扫描检测骨转移瘤价值的比较

目的:评价18FDG-PET恶性肿瘤骨转移的作用及与99mTc-MDP-ECT 比较.材料和方法: 经病理证实为恶性肿瘤患者51 例及非肿瘤性疾病5例在本科同时接受18F-FDG-PET和99mTc-MDP-ECT检查(时间间隔不超过2周).骨转移的诊断由病理、X线或CT/MRI、随访超过1年综合决定.结果:99mTc-MDP和18FDG-PET 对骨转移瘤诊断的灵敏度、特异性、准确率率分别为93.7%、93.7%,97.5%、50%,90.8%、62.5%.99mTc-MDP和18FDG-PET均为阳性15例,其中证实骨转移为14例,假阳性1例;均为阴性例数为20例.21例不相符的结果中20例99mTc-MDP-ECT 阳性而18F-FDG-PET 为阴性.18F-FDG-PET和99mTc-MDP-ECT假阴性各1例.均诊断为多发骨转移的12例患者中99mTc-MDP-ECT发现的骨转移病灶数多于18F-FDG-PET.结论:18F-FDG-PET 与99mTc-MDP骨扫描相比较对肿瘤骨转移的探测有较高的特异性,但敏感性较低.     

Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation

Fever of unknown origin (FUO) and suspected focal infection or inflammation are challenging medical problems. The aim of this study was to assess the value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients with FUO and patients with suspected focal infection or inflammation. All FDG PET scans ordered because of FUO or suspected focal infection or inflammation in the last 4 years were reviewed. These results were compared with the final diagnosis. Thirty-five FDG PET scans were performed in 35 patients with FUO. A final diagnosis was established in 19 patients (54%). Of the total number of scans, 37% were clinically helpful. The positive predictive value of FDG PET in these patients was 87% and the negative predictive value was 95%. Fifty-five FDG PET scans were performed in 48 patients with suspected focal infection or inflammation. A final diagnosis was established in 38 patients (82%). Of the total number of scans, 65% were clinically helpful. The positive predictive value of FDG PET in these 55 episodes of suspected infection or inflammation was 95% and the negative predictive value was 100%. It is concluded that FDG PET appears to be a valuable imaging technique in the evaluation of FUO and suspected focal infection or inflammation. Furthermore, FDG PET could become a useful tool for evaluating the effect of treatment of infectious and inflammatory processes that cannot reliably be visualised by conventional techniques. However, to assess the additional diagnostic value of this technique, prospective studies of FDG PET as part of a structured diagnostic protocol are warranted.     

^18FDG-PET诊断胃癌及影响因素

目的 :评价18FDG PET对胃癌的诊断价值和胃肠生理性摄取等因素对诊断的影响。材料和方法 :无消化道疾病史的FDG PET查体者 3 0 3例为组 1;PET发现胃部最大SUV值≥ 3 .5 ,并在 1～ 2周内接受胃镜检查者 2 7例为组 2 ;胃镜初步诊断为胃癌且经PET检查、手术和病理检查 3 3例为组 3。用ROI方法测定胃等病灶SUV最大值 (SUVmax)和平均值(SUVave)。结果 :组 1胃部FDG摄取SUVmax为 0 .71～ 5 .7,SUVave为 0 .61～ 4.6。 16%胃SUVmax<1.5 ;5 5 %SUVmax>2 .0 ;17%SUVmax>3 .0 ;6%SUVmax>3 .5。组 2胃部SUVmax3 .5～ 5 .7,胃镜证实 19例正常 ,5例胃炎 ,3例溃疡 ;炎性及溃疡病变FDG摄取高于正常胃 (p <0 .0 5 )。PET检出组 3原发病灶 97% ( 3 1/ 3 2 ) ;远处转移 6/ 6;胃局部淋巴结转移 6/ 11。假阴性 1例 ,纠正胃镜误诊 1例 ,上调UVmax从≥ 3 .0至≥ 3 .5 ,则组 1中假阳性从 17%降至 6% ,组 3假阴性仍保持不变。结论 :提高SUV阈值可减少胃肠道生理或 /和炎性摄取对结果的影响。     

Prognostic Value of SUVmax Measured by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography in Patients with Gallbladder Cancer

Objective

The aim of this study is to investigate the prognostic value of F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computed tomography (CT) in gallbladder cancer patients.

Methods

From June 2004 to June 2010, a total of 50 patients with gallbladder cancer who underwent diagnostic staging with F-18 FDG PET/CT following curative or palliative treatments were retrospectively evaluated. For the analysis, all patients were classified by age, sex, maximum standardized uptake value (SUVmax), lymph node (LN) or distant metastasis, serum level of CA19-9 and CEA, type of treatment and American Joint Committee on Cancer (AJCC) stage.

Results

The median survival for the 50 patients was 245 days and the median SUVmax in PET/CT was 8.3 (range, 0-19.7). Patients with SUVmax < 6 survived significantly longer than patients with SUVmax ≥ 6 (median 405 days vs 203 days, p = 0.0400). On Kaplan-Meier analysis, SUVmax (p = 0.0400), stage (p = 0.0001), CA19-9 (p = 0.013), CEA (p = 0.006), LN metastasis (p = 0.0001), distant metastasis (p = 0.0020), type of treatment (p = 0.0001) were significantly associated with overall survival. Multivariate analysis study revealed that the patients with lower SUVmax measured from initial staging PET/CT (p = 0.0380), no LN metastasis (p = 0.0260), a lower stage (p = 0.026) and curative treatment (p = 0.0005) had longer survivals.

Conclusions

The present study shows that SUVmax on F-18 FDG PET/CT can provide prognostic information in patients with gallbladder cancer.     

Anatomo-metabolic characteristics of atelectasis in F-18 FDG-PET/CT imaging

PURPOSE: To evaluate the structural and metabolic characteristics of atelectasis in FDG-PET/CT. METHODS: Twenty one consecutive patients (13 males, 8 females, median age 67 years) with CT features of atelectasis, undergoing PET/CT imaging for preoperative staging of histologically proven malignancies (20 lung cancer and 1 ovarian cancer metastasis to lung), were included in the study. RESULTS: Hounsfield units of atelectasis (-383.58+/-189, range -631 to 82) were significantly higher than in normal lung (-756+/-67.46, range -839 to -555; P=0.0001), and lower than in malignant tissue (35+/-19, range 4-77; P=0.0001). The main patterns of FDG uptake observed in atelectasis were diffuse and homogenous. The standard uptake value (SUV) in atelectasis was low to moderate (SUV(avg): 1.13+/-0.50; SUV(max): 1.44+/-0.54), and generally lower than in tumor tissue (SUV(avg): 6.25+/-3.58, range 2.0-16.5), but always higher than in normal lung (0.56+/-0.18 and 0.70+/-0.23, respectively) (P=0.0001). There was a positive correlation between the density of atelectatic lesions and the degree of uptake, with no relationship to size. CONCLUSION: There is a positive relationship between the density of collapsed lung and the intensity of FDG uptake. FDG uptake in atelectasis is higher than in normal lung, and generally lower than in tumor tissue.     

Myocarditis on 18FDG-PET imaging

Myocarditis is the inflammation of the heart muscle with various clinical presentations and etiology. In this case, we demonstrate the utility of Fluorodeoxyglucose PET scan in identifying its etiology. A 28-year-old female with a history of undifferentiated connective tissue disease and sacroiliitis referred to the cardiology clinic for palpitations. Her symptoms started 3 years ago, were episodic, associated with fatigue, and impaired quality of her life. A resting electrocardiogram revealed sinus tachycardia. Medical workup for sinus tachycardia was unremarkable. Given suspicion for idiopathic myocarditis, a FDG PET using F18 was ordered and revealed diffuse myocardial uptake suggestive of myocarditis. Normal LV systolic function was noted on the echocardiogram. Her tachycardia was successfully treated with ivabradine and diltiazem. She was started on mycophenolate mofetil for myocarditis with improvement in symptoms of tachycardia and fatigue. A repeat FDG PET in follow-up revealed less diffuse uptake with the initiation of therapy. FDG-PET may add value in patients with inappropriate sinus tachycardia found especially if suspicion of underlying connective tissue disease exists. As illustrated in this case, a timely diagnosis could change management decisions as well as significantly impact the quality of life.     

FDG-PET/CT in re-staging of patients with lymphoma

The aim of this study was to evaluate the clinical significance of combined fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in patients with lymphoma, and to compare the FDG-PET/CT staging results with those of FDG-PET and CT alone. Twenty-seven patients were studied. Each patient had clinical follow-up for >12 months and entered complete follow-up evaluation. Patient-based evaluation showed a sensitivity of 78% for CT alone, 86% for FDG-PET alone, 93% for CT and FDG-PET read side by side, and 93% for combined FDG-PET/CT imaging. Region-based evaluation showed a sensitivity for regional lymph node involvement of 61%, 78%, 91% and 96% respectively. FDG-PET/CT imaging is superior to CT alone (P=0.02) and has additional benefit over FDG-PET alone due to exact anatomical localisation. We conclude that FDG-PET/CT imaging is accurate in re-staging lymphoma and offers advantages over separate FDG-PET and CT imaging.     

Diagnosis of Cardiac Metastasis from Endometrial Cancer by F-18 FDG-PET/CT

We report a case of a 59-year-old woman with right ventricular metastasis of undifferentiated endometrial cancer. Cardiac metastasis from endometrial cancer is a very rare finding. The case demonstrates that undifferentiated endometrial cancer is capable of metastasizing, presumably through a hematogenous route, to unexpected distant organs. These unexpected sites should not be undermined in the restaging and surveillance of these patients.